Here Comes Human Heart, 2.1

The source of life is going modular – again.

The human heart changed forever in 1967. It went modular. The development of cardiac transplantation that year meant that hearts could now be switched in and out like flashlight batteries. But that was only the beginning. A whole array of mechanical devices can now be plugged into the heart to keep it going for months, or years – or replace it altogether. Cleveland Clinic has been at the forefront of developing these devices, which may someday make transplant unnecessary.

First, they did harm

The first heart transplants were done in a spirit of scientific exuberance. Surgeons quickly mastered the technical difficulties of harvesting and implanting donor hearts. But keeping the patient alive with a donor heart proved to be tricky. Every fiber in the body conspired to reject the new organ. Infections were difficult to control . There were no guidelines for who needed or should be getting a transplanted heart. Survival rates were unacceptable. Cleveland Clinic did two heart transplants in 1968 – then decisively ordered that no more be performed until the procedure could be done safely with minimal risk to the patient. That took another 17 years.

Let’s try this again

In 1984 there was a truck accident on the freeway not far from Cleveland Clinic. A 25-year-old waitress was killed. Her family generously donated her heart to Cleveland Clinic for what would be the first operation in its newly revived heart transplant program. The recipient was a 50-year-old man from Akron, Ohio. Much had changed since the late 1960s. The FDA had just approved an effective new anti-rejection drug, cyclosporine. Patient selection criteria had been refined. The risk of infection was reduced by the introduction of new laminar-flow operating rooms.

Making up for lost time

Cleveland Clinic surgeons went on a roll. In 1998, they set a new world record for the most heart transplants performed in a single year at a single institution (113). Survival rates were well above the national average. By 2012, they had done more than 1,600 heart transplants on people from all walks of life. Hundreds of donor families and recipients came together for moving annual reunions at Cleveland Clinic’s main campus. This year, the heart transplant program turns 30 – one of ten solid organ transplant programs in the Cleveland Clinic Transplant Center.

Human Heart 2.1

Why do people get heart transplants? Number one reason: heart failure. A failing heart can be caused by a heart attack or damage to the heart muscle – or it can be gradual and ultimately fatal swelling and weakening of the heart tissue. There’s no cure for a damaged heart. Up until recently, transplant has been the only available treatment for end-stage heart failure. But that is changing.

As far back as the 1950s, Cleveland Clinic researchers began experimenting with artificial hearts. Today, they are using heart assist devices and working on small implantable artificial hearts that are transforming the treatment of heart failure, and will ultimately lessen the dependence on scarce donor organs. Some of these mechanical hearts “beat”, some have rotors that ride a magnetic wave and spin blood through the body without a pulse. Implantable devices today are already competent substitutes for heart transplant for a certain group of heart failure patients.

Today, Cleveland Clinic surgeons are performing as many device implantations as heart transplantations. From transplant, to mechanical assist device, to – someday – a totally implantable artificial heart: the saga of the modular heart continues…